Reporting MIPS in 2018

Transcription

1 Reprting MIPS in 2018 Rebecca Hancck, MHA, Directr, IRIS Registry Jessica Petersn, MD, MPH, Manager, Quality & HIT Plicy Sue Vicchrilli, COT, OCS, Directr, Cding & Reimbursement

2 Reprting Optins IRIS Registry and yur EHR Grup and Individual Reprting EHR via yur vendr Grup and Individual Reprting IRIS Registry manual entry Clinical Cluster Reprting Claims Individual Reprting ONLY 2

3 Target Dates June 1, 2018 Last date t register fr first-time EHR integratin with IRIS Registry fr 2018 MIPS Summer 2018 IRIS Registry pens fr 2018 MIPS reprting Aug. 1, 2018 Integratin shuld be cmplete fr 2018 IRIS Registry EHR reprting Oct. 31, 2018 Last date t register with IRIS Registry t manually reprt MIPS data fr 2018 reprting 3

4 Reprting Target Dates Jan. 15, 2019 IRIS Registry data entry must be cmplete Data release cnsent frm must be signed. March 1, 2019 Claims reprting deadline fr claims prcessing. 4

5 Autmatic Exemptins Lw-vlume threshld: Less than $90,000 in Medicare Part B allwables, r Fewer than 200 Medicare Part B patients. CMS will ntify clinicians/grups f exemptin status. Shuld be able t check website in spring 2018 if autmatically exempt: 5

6 Avid the Penalty in 2020 Penalty f up t 5 percent f all Medicare Part B payments in 2020, including Part B drug payments 15-pint MIPS final scre t avid penalty Hw t d it: Reprt 6 quality measures, a clinical cluster r Reprt the imprvement activity categry 6

7 MIPS 4 Categries fr Evaluatin 50% 25% 15% 10% Quality measures Advancing care infrmatin Imprvement activities Cst

8 Small-Practice Accmmdatins Wh cunts: Practices with 15 r fewer eligible clinicians Maintained: 2017 accmmdatins fr imprvement activities (duble credit fr each activity) New in 2018: 5-pint bnus added t MIPS final scre Small practice hardship under advancing care infrmatin 8

9 MIPS 4 Categries fr Evaluatin 50% Quality measures

10 Quality Weighted 50 Percent Reprt 6 measures, including ne utcme r high-pririty measure (if n utcme measure available) Nn-EHR IRIS Registry practices can reprt a clinical cluster 60 percent f patients, all payers (Medicare nly if reprting by claims) Reprt fr the full calendar year Measures reprted n less than 60 percent f patients r less than a full year earn ne pint (three pints fr small practices) Categry imprvement scre Wrth up t 10 percent added int quality scre 10

11 MIPS 4 Categries fr Evaluatin 25% Advancing care infrmatin

12 Advancing Care Infrmatin Categry scre: weighted 25 percent Must submit all 4 (2014 CEHRT) r 5 (2015 CEHRT) base measures t receive any credit Ttal categry scre = Base scre (50 pints) + Perfrmance scre (90 Pints) + Bnus scre (25 Pints) Capped at 100 pints 12

13 Advancing Care Infrmatin Test pace: Fulfill and reprt all base measures (50 pints) Each measure requires a numeratr and denminatr f at least 1 Cmmnly audited: Security risk analysis measure dcument prperly! Partial and full participatin: Perfrmance + bnus scre capped at 50 pints Varius perfrmance and bnus measures t reprt n, all with different pint values Perfrmance scring: Based n numeratr/denminatr Participatin with the IRIS Registry (with an integrated EHR system): 10 pints Bnus: Cmpleting certain imprvement activities using CEHRT: 10 pints Exclusive use f 2015 CEHRT fr ACI reprting: 10 pints 13

14 Advancing Care Infrmatin Base Measures Each measure requires at least ONE patient in the numeratr Base Measures 2014 CEHRT 2015 CEHRT Reprting Requirement Security Risk Analysis Security Risk Analysis Yes/N E-Prescribing E-Prescribing Numeratr/denminatr Prvide Patient Access Prvide Patient Access Numeratr/denminatr Health Infrmatin Exchange Send a Summary f Care Numeratr/denminatr Request/Accept Summary f Care Numeratr/denminatr 14

15 Advancing Care Infrmatin Perfrmance Measures Perfrmance Measures 2014 CEHRT % (Pints) Reprting Requirement Prvide Patient Access Up t 20 Numeratr/denminatr Health Infrmatin Exchange Up t 20 Numeratr/denminatr View, Dwnlad r Transmit Up t 10 Numeratr/denminatr Patient-Specific Educatin Up t 10 Numeratr/denminatr Secure Messaging Up t 10 Numeratr/denminatr Medicatin Recnciliatin Up t 10 Numeratr/denminatr Public Health and Clinical Data Registry Reprting 0 r 10 Yes/N 15

16 Advancing Care Infrmatin Perfrmance Measure Scring Perfrmance Rates fr Each Measure Wrth Up t 10% Perfrmance Rate 1-10 = 1% Perfrmance Rate = 6% Perfrmance Rate = 2% Perfrmance Rate = 7% Perfrmance Rate = 3% Perfrmance Rate = 8% Perfrmance Rate = 4% Perfrmance Rate = 9% Perfrmance Rate = 5% Perfrmance Rate = 10% Example: If a MIPS-eligible clinician submits a numeratr and denminatr f 85/100 fr the Patient-Specific Educatin measure, their perfrmance rate wuld be 85%, and they wuld earn 9 ut f 10 percentage pints fr that measure. 16

17 Advancing Care Infrmatin Bnus Measures Bnus Measures Measure % (Pints) Reprting Requirement Active Participatin in a Registry 0 r 5 Yes/N Cmpletin f Certain Imprvement Activities Using CEHRT 0 r 10 Yes/N Use 2015 CEHRT fr ACI reprting 0 r 10 Yes/N 17

18 Advancing Care Infrmatin Reprting Reprt all ACI measures n the same 90+ cnsecutive day perid. IRIS Registry fr advancing care infrmatin reprting: The IRIS Registry can submit advancing care infrmatin attestatin alng with yur quality and imprvement activities perfrmance Integrated IRIS Registry users earn 10 advancing care infrmatin perfrmance pints Grup reprting If yu reprt advancing care infrmatin as a grup, yu must reprt all categries (quality, imprvement activities, cst) as a grup Grup reprting helps accmmdate clinicians wh d nt use EHRs Yu can nly reprt patient encunters captured in CEHRT tward advancing care infrmatin 18

19 Advancing Care Infrmatin Hardship Reweighting CMS may reweight ACI categry pints tward the quality categry. As a result: ACI categry weight decreases frm 25 percent t 0 percent f final MIPS scre and Quality categry weight increases frm 50 percent t 75 percent f final MIPS scre If yu qualify fr autmatic reweighting, ACI reprting is ptinal Autmatic Reweighting Hspital-based clinicians Nn-patient facing clinicians NP, PA, CRNA, CNS Hardship Insufficient internet cnnectivity Extreme and uncntrllable circumstances Lack f cntrl ver availability f CEHRT Small practices (beginning in 2018) 19

20 2017 Prgram Changes in 2018 Final Rule New measure exclusins (starting in 2017 perfrmance year) HIE/Send a Summary f Care Exclusin fr thse with <100 referrals/transitins f care in the perfrmance perid Request/Accept Summary f Care Exclusin fr thse wh receive <100 referrals/transitins f care E-Prescribing Exclusin fr thse with <100 eligible prescriptins 20

21 2017 Prgram Changes in 2018 Final Rule Advancing care infrmatin: Earlier hardship-applicatin deadline: Dec. 31 f perfrmance year 21

22 2018 Advancing Care Infrmatin Wins! Credit fr IRIS participatin Increased t 10 pints in 2018 frm 5 pints in 2017 Delay f 2015 CEHRT Requirement 10-pint categry bnus fr using 2015 CEHRT exclusively New hardships Clinicians whse EHR was decertified can apply fr decertificatin exceptin Small practices ( 15 eligible clinicians) Reweight advancing care infrmatin t 0 percent, quality t 85 percent N term limit n hardships, except fr EHR decertificatin Previusly, yu culd nly get hardships fr a maximum f five years 22

23 MIPS 4 Categries fr Evaluatin 15% Imprvement activities

24 Imprvement Activities Categry scre: weighted 15 percent Ttal categry scre is capped at 40 pints Hw t fulfill the categry Small practices ( 15 clinicians) 1 high-weighted imprvement activity, OR 2 medium-weighted imprvement activities. Larger practices (> 15 clinicians) 2 high-weighted imprvement activities, 4 medium-weighted imprvement activities, OR 1 high-weighted imprvement activity AND 2 medium-weighted imprvement activities. 24

25 Imprvement Activities Reprting Reprt and dcument imprvement activities ver a 90+ cnsecutive day perfrmance perid. Use the IRIS Registry t reprt imprvement activities Other reprting ptins may include yur EHR vendr r the CMS attestatin prtal. Grup reprting If yu reprt imprvement activities as a grup, yu must reprt all categries (quality, ACI, cst) as a grup At least ne clinician in the grup must cmplete the imprvement activity The entire grup gets credit as lng as ne clinician perfrms the activity(ies). 25

26 Imprvement Activities Minr mdificatins include: IA_AHE_1 Engagement f New Medicaid Patients and Fllw-Up Timely = 10 business days IA_EPA_1 24/7 Patient Access added telehealth Small practices still receive duble pints 26

27 MIPS 4 Categries fr Evaluatin 10% Cst

28 Cst Categry scre: weighted at 10 percent in 2018 perfrmance year. CMS will evaluate tw measures: Medicare spending per beneficiary, and Ttal per capita cst per attributed beneficiary Reprting: Based n claims data. Hw t prepare: Dwnlad yur QRUR - g t aa.rg/qrur t learn mre Cntact QualityNet Help Desk at r healthplicy@aa.rg if yu have questins 28

29 IRIS Registry Participatin Update

30 IRIS Registry Statistics As f Oct. 1, 2017: Ttal: 16,503 physicians frm 5,119 practices With EHR integratin: 13,046 physicians frm 3,057 practices Patient visits: millin, representing millin patients 30

31 50 EHR Systems Integrated with IRIS Registry Amazing Charts EyeMD EMR ManagementPlus NeMed ChartLgic GE Centricity EMR Mastermind EHR NexTech ChartMaker Medical Suite ClinixMD Cmpulink Crystal PM DctrSft eclinicalwrks emds EnableDc Epic ExamWRITER EyeDc EMR Greenway Intergy Greenway/Primesuite HCIT HER ifa systems EMR imedicware IMS Integrity EMR fr Eyes IO Practiceware ipatientcare KeyChart EMR KeyMedical Sftware MacPractice MD MaximEyes by First Insight MDIntelleSys Intellichart Pr MDffice Medent MedEvlve Medflw Medinfrmatix HER Meridian Mdernizing Medicine My Visin Express NextGen Origin Prime Clinical System PrgnCIS Sapware SRS TriMed EHR VersaSuite Vitera EHR 31

32 IRIS Registry Penalty Avidance IRIS Registry has saved participants ver $185 millin in estimated penalties avided since 2014: 2014: $17 millin 2015: $73 millin 2016: $95 millin 2019 MIPS penalty fr 2017 reprting: 4 percent - an estimated $18,600 fr the average phthalmlgist 32

33 Hw IRIS Registry Will Supprt 2018 MIPS Reprting

34 MIPS 2018 Ttal 2018 MIPS payment adjustment depends n final MIPS scre: <15 pints: 5 percent penalty 15 pints: neutral (n adjustment) >15 pints: bnus (up t 5 percent) >70 pints: exceptinal-perfrmance bnus The IRIS Registry will cntinue t supprt all MIPS-scre gals fr practices with r withut an EHR system 34

35 IRIS Registry and MIPS

36 2018 Quality Measures: ecqms Expected quality measures fr IRIS Registry participants with integrated EHR systems: Clsing the Referral Lp: Receipt f Specialist Reprt high pririty Dcumentatin f Current Medicatins in the Medical Recrd high pririty Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw-Up Plan Pneumnia Vaccinatin Status fr Older Adults Diabetes: Eye Exam Cataracts: Cmplicatins within 30 Days Fllwing Cataract Surgery Requiring Additinal Surgical Prcedures - utcme Cataracts: 20/40 r Better Visual Acuity within 90 Days Fllwing Cataract Surgery - utcme Preventive Care and Screening Tbacc Use: Screening and Cessatin Interventin Falls: Screening fr Fall Risk high pririty Diabetic Retinpathy: Cmmunicatin with the Physician Managing Onging Diabetes Care high pririty Primary Open Angle Glaucma (POAG): Optic Nerve Evaluatin Preventive Care and Screening: Influenza Immunizatin Use f High-Risk Medicatins in the Elderly high pririty Diabetic Retinpathy: Presence r Absence f Macular Edema and Level f Severity f Retinpathy 36

37 Quality: IRIS Registry EHR Reprters Mnitr yur dashbard t review yur quality perfrmance and MIPS scres 37

38 2018 Quality Measures: Manual Entry (nn-ehr) Diabetes: Hemglbin A1c Pr Cntrl, Outcme Primary Open Angle Glaucma: Optic Nerve Evaluatin Age-related Macular Degeneratin: Dilated Macular Examinatin Diabetic Retinpathy: Cmmunicatin with the Physician Managing Onging Diabetes Care, High Pririty Preventive Care and Screening: Influenza Immunizatin Pneumnia Vaccinatin Status fr Older Adults Diabetes: Eye Exam Dcumentatin f Current Medicatins in the Medical Recrd, High Pririty Melanma: Cntinuity f Care Recall System, High Pririty Melanma: Crdinatin f Care, High Pririty Age-related Macular Degeneratin: Cunseling n Antixidant Supplement Primary Open-Angle Glaucma: Reductin f Intracular Pressure (IOP) by 15% OR Dcumentatin f a Plan f Care, Outcme Cataracts: 20/40 r Better Visual Acuity within 90 Days Fllwing Cataract Surgery, Outcme Cataracts: Cmplicatins within 30 Days Fllwing Cataract Surgery Requiring Additinal Surgical Prcedures, Outcme Melanma: Overutilizatin f Imaging Studies in Melanma, High Pririty Preventive Care and Screening Tbacc Use: Screening and Cessatin Interventin Use f High-Risk Medicatins in the Elderly, High Pririty Bipsy fllw-up, High Pririty Preventive Care and Screening: Screening fr High Bld Pressure and Fllw-Up Dcumented Adult Primary Rhegmatgenus Retinal Detachment Surgery: Return t OR, Outcme Adult Primary Rhegmatgenus Retinal Detachment Surgery: Imprvement in Visual Acuity, Outcme Cataract Surgery with Intra-Operative Cmplicatins (Unplanned Rupture f Psterir Capsule Requiring Unplanned Vitrectmy), Outcme Cataract Surgery: Difference Between Planned and Final Refractin, Outcme Melanma Reprting, High Pririty Tbacc use and help quitting amng adlescents Overuse f Neurimaging fr Patients with Primary Headache and Nrmal Neurlgical Examinatin, High Pririty 38

39 QCDR Measures Additinal subspecialty eye care utcme and high pririty QCDR quality measures fr 2018 reprting are under CMS evaluatin Academy will annunce nce these measures are apprved 39

40 IRIS Registry Nn-EHR: 2 Optins #1: Pick a clinical cluster t reprt fr a full year n 60 percent f patients: Primary pen-angle glaucma POAG ptic-nerve evaluatin Reductin in IOP by 15 percent r dcumentatin f care plan Age-related macular degeneratin Dilated macular exam Cunseling antixidant supplements Retinal care: Retinal-detach return t OR 90 days Retinal-detach VA imprvement 90 days #2: Reprt six measures (including ne utcme measure r high-pririty measure) and reprt fr a full year n 60 percent f patients Partial credit awarded even if yu reprt n fewer than six measures 40

41 Quality: IRIS Registry Manual Reprters (nn-ehr) Manually select measures and input patient data in the IRIS Registry 41

42 Imprvement Activities Weighted 15 Percent Attest that yu have cmpleted enugh imprvement activities fr a 90-day perid t reach 40 pints (small practices earn duble pints) Nte: This is the easy categry in 2018 fr practices that want t avid penalties 42

43 2017 Advancing Care Infrmatin Weighted 25 Percent Reprt advancing care infrmatin measures fr base and perfrmance scres IRIS Registry participants: Earn 10 perfrmance pints fr participating in the IRIS Registry Earn 10 percent bnus fr cmpleting a clinical practice imprvement activity using CEHRT 43

44 Reprt Advancing Care Infrmatin Using the IRIS Registry Select CEHRT editin, advancing care infrmatin measure set, timeframe and enter measure numeratrs and denminatrs, r answer yes/n: 44

45 IRIS Registry MIPS Scre Calculatr The IRIS Registry will give participants an estimated MIPS scre n three categries, based n data cllected: 45

46 ACO Participants and IRIS Registry Accuntable care rganizatins must meet their wn quality-reprting standards, based mstly n primary-care measures Under MIPS, ACO participants can reprt using the IRIS Registry If the ACO fails t meet its quality-reprting bligatins, this will prtect participants frm autmatic penalties 46

47 Participate in the Academy s IRIS Registry Benefits f IRIS Registry participatin include: Helps meet quality-reprting requirements Prvides at least ne utcme r high pririty measure fr mst participants t reprt Supprts credit fr imprvement activities Facilitates advancing care infrmatin reprting by including a web entry prtal Earn bnus quality pints thrugh IRIS Registry participatin: Fr reprting multiple utcmes measures Fr electrnic reprting thrugh an IRIS Registry-integrated EHR system 47

48 Academy Resurces Washingtn Reprt Express ed every Thursday evening. It s the first place yu will see any changes discussed and explained. MIPS manual: MIPS webpages Quality: ACI: Imprvement Activities: MIPS landing page: aa.rg/medicare Cntains links t all f the abve infrmatin (except Washingtn Reprt Express) Will link t any new resurces we add. IRIS Registry sign-up: (first-time users) questins t mips@aa.rg. 48

49